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Background  The recent push for the publication of individual surgeon outcomes underpins public interest in safer surgery. Conventional, retrospective assessment of surgical performance without continuous monitoring may lead to delays in identifying poor performance or recognition of practices that lead to be better than expected performance.    Discussion  The variable life adjusted display (VLAD) is not new, yet is not widely utilised in General Surgery. Its construction is simple and if caveats are appreciated the interpretation is straightforward, allowing for continuous surveillance of surgical performance.    Summary  While limitations in the detection of variations in performance are appreciated, the VLAD could represent a more useful tool for monitoring performance.

Debate: should we use variable adjusted life displays (VLAD) to identify variations in performance in general surgery?